Financial Policy
We are committed to providing you the best available medical care. Our personnel will be pleased to discuss our fees and this policy with you at any time. Our professional relationship will be enhanced by your clear understanding of our Financial Policy. Thank you for your review and acceptance of this policy.
All new patients must fully complete our New Patient Information Form before seeing the doctor.
Full payment for our services is due at the time of service, unless other mutually agreed upon arrangements are made with our office staff.
We accept payment by cash, check, VISA or MasterCard.
INSURANCE
You are responsible for the timely payment of your account. Insurance is a contract between you and your insurance company. We are not a party to this contract, nor can we be involved in disputes between you and your insurer regarding deductibles, co-payments, covered charges, secondary insurance, "usual and customary" or allowable charges, etc. Our involvement will be limited to supplying factual information to facilitate claim processing.
Medicare
We are a participating Medicare provider; thus, we accept assignment on your claims. We are required by Medicare to file your claims for you. Medicare will pay us directly and provide you an EOB (Explanation of Benefits) detailing allowances, payments or denials. You are responsible for payment of deductibles, co-payments and any service not covered by Medicare (i.e., cosmetic surgery). If you have supplemental insurance, we will file your claims only if your insurer coordinates benefits with Medicare (those companies having an agreement with Medicare to process secondary balance claims upon direct notification of payment from Medicare).
Medicaid / Title 19
We accept Medicaid patients, and we file claims directly with the Medicaid program. A valid Medicaid certificate must be presented at each visit, and
All new patients must fully complete our New Patient Information Form before seeing the doctor.
Full payment for our services is due at the time of service, unless other mutually agreed upon arrangements are made with our office staff.
We accept payment by cash, check, VISA or MasterCard.
INSURANCE
You are responsible for the timely payment of your account. Insurance is a contract between you and your insurance company. We are not a party to this contract, nor can we be involved in disputes between you and your insurer regarding deductibles, co-payments, covered charges, secondary insurance, "usual and customary" or allowable charges, etc. Our involvement will be limited to supplying factual information to facilitate claim processing.
Medicare
We are a participating Medicare provider; thus, we accept assignment on your claims. We are required by Medicare to file your claims for you. Medicare will pay us directly and provide you an EOB (Explanation of Benefits) detailing allowances, payments or denials. You are responsible for payment of deductibles, co-payments and any service not covered by Medicare (i.e., cosmetic surgery). If you have supplemental insurance, we will file your claims only if your insurer coordinates benefits with Medicare (those companies having an agreement with Medicare to process secondary balance claims upon direct notification of payment from Medicare).
Medicaid / Title 19
We accept Medicaid patients, and we file claims directly with the Medicaid program. A valid Medicaid certificate must be presented at each visit, and
we are required to collect a co-payment at the time of service.
Blue Cross/Blue Shield
We are a participating provider with Blue Cross/Blue Shield of Wyoming, and our agreement allows us to file claims for the covered portion of the bill directly with them. Your policy must be in force with no pre-existing conditions or other exclusions. Full payment of (1) the co-payment, (2) any prorated or shared cost (i.e., 20% of covered charges in a 80/20 plan), and/or (3) any amount that may be applied towards the deductible is due from the patient at the time of service.
Third party payers (All other health insurance)
As a service to you, we will file your primary insurance claim for you, provided that (a) the patient is covered by the insurance plan, (b) the plan is in force and there are no policy exclusions that apply (i.e., pre-existing conditions, non-covered services, etc.) and (c) that full payment of (1) the co-payment, (2) any prorated or shared cost (i.e., 20% of covered charges in a 80/20 plan), and/or (3) any amount that may be applied towards the deductible is due from the patient at the time of service. We will provide you with the information you need to submit any secondary insurance claim you may have.
No Insurance
Full payment for our services is due at the time of service, unless other mutually agreed upon arrangements are made with our office staff. We accept payment by cash, check, VISA or MasterCard, to make this easier for you. We have financial options available to help you with your bill if your circumstances require. Please contact our office staff ahead of time to let us know how we can be of help. There are community resources available to help you or your family with medical expenses.
We will gladly discuss your proposed treatment and answer any questions we can regarding our fees.
A finance charge is computed on all patient accounts whose balance still remains unpaid 30 days after the first billing. The periodic rate is 1.5% per month; the annual percentage rate is 18%. Checks dishonored by your financial institution for any reason are subject to a $35 processing fee by our office.
Blue Cross/Blue Shield
We are a participating provider with Blue Cross/Blue Shield of Wyoming, and our agreement allows us to file claims for the covered portion of the bill directly with them. Your policy must be in force with no pre-existing conditions or other exclusions. Full payment of (1) the co-payment, (2) any prorated or shared cost (i.e., 20% of covered charges in a 80/20 plan), and/or (3) any amount that may be applied towards the deductible is due from the patient at the time of service.
Third party payers (All other health insurance)
As a service to you, we will file your primary insurance claim for you, provided that (a) the patient is covered by the insurance plan, (b) the plan is in force and there are no policy exclusions that apply (i.e., pre-existing conditions, non-covered services, etc.) and (c) that full payment of (1) the co-payment, (2) any prorated or shared cost (i.e., 20% of covered charges in a 80/20 plan), and/or (3) any amount that may be applied towards the deductible is due from the patient at the time of service. We will provide you with the information you need to submit any secondary insurance claim you may have.
No Insurance
Full payment for our services is due at the time of service, unless other mutually agreed upon arrangements are made with our office staff. We accept payment by cash, check, VISA or MasterCard, to make this easier for you. We have financial options available to help you with your bill if your circumstances require. Please contact our office staff ahead of time to let us know how we can be of help. There are community resources available to help you or your family with medical expenses.
We will gladly discuss your proposed treatment and answer any questions we can regarding our fees.
A finance charge is computed on all patient accounts whose balance still remains unpaid 30 days after the first billing. The periodic rate is 1.5% per month; the annual percentage rate is 18%. Checks dishonored by your financial institution for any reason are subject to a $35 processing fee by our office.